PSA和PSAD在前列腺癌诊断及预后判定中的意义

Significance of serum PSA,PSAD in diagnosis and prognosis in patients with prostatic adenocarcinoma

目的：探讨血清前列腺特异抗原（PSA）、前列腺特异抗原密度（PSAD）在前列腺癌诊断及预后判定中的价值。方法：前列腺癌组患者28例，前列腺增生组患者81例。采用放射免疫法测定2组患者血清PSA水平和PS—AD值，并进行了比较，同时比较了不同临床分期及Gleason评分前列腺癌患者血清PSA水平。结果：（1）前列腺癌组患者血清PSA水平和PSAD值均明显高于前列腺增生组患者（P〈0．01）；（2）PSA阈值定为4ng／ml时，前列腺癌检测敏感性、特异性、阳性预测值分别为89．29％、59．26％、43．10％。PSAD阈值定为0．15时，前列腺癌检测敏感性、特异性、阳性预测值分别为81．82％、80．85％、66．67％。（3）A、B期和C、D期前列腺癌患者血清PSA水平差异无统计学意义（P〉0．05）；Gleason评分2～6分和7～10分前列腺癌患者PSA水平差异亦无统计学意义（P〉0．05）。结论：PSA和PSAD在前列腺癌诊断中均有一定的价值，PSAD的诊断价值可能更大。

Objective： To evaluate the diagnosis and prognosis value of serum prostate specific antigen （PSA） and prostate specific antigen density （PSAD） in patients with prostatic adenocarcinoma. Methods： Both 28 patients with prostatic adenocarcinoma and 81 patients with benign prostate hyperplasia （BPH） were determined by pathological examination. PSA and PSAD levels in patients with prostatic adenocarcinoma were compared with that in patients with BPH. The relationships between PSA levels and clinical stages, pathological grades in patients with prostatic adenocarcinoma were evaluated. Results. （1） PSA and PSAD levels in patients with prostatic adenocarcinoma were higher than that in patients with BPH （P〈0.01）. （2）when PSA level was of 4ng/ml or greater, the sensitivity, specificity and positive predictive value of PSA was 89.29 %, 59.29 % and 43.10 % respectively as a method to detect prostatic adenocarcinoma. When PSAD level was 0.15 or greater, the sensitivity, specificity and positive predictive value of PSAD was 81.82%, 80.85% and 66.67%A respectively as a method to detect prostatic adenocarcinoma. （3） PSA level was no difference between A and B stage and C to D stage in patients with prostatic adenocarcinoma. PSA level was no difference between Gleason scores less than 7 and Gleason scores 7 or greater. Conclusions： Both PAS and PASD have good values to detect prostatic adenocarcinoma and PASD may be better.